Delirium

DELIRIUM, med.jur. A disease of the mind produced by inflammations,
particularly in fevers, and other bodily diseases.
2. It is also occasioned by intoxicating agents.
3. Delirium manifests its first appearance "by a propensity of the
patient to talk during sleep, and a momentary forgetfulness of his
situation, and of things about him, on waking from it. And after being fully
aroused, however, and his senses collected, the mind is comparatively clear
and tranquil, till the next slumber, when the same scene is repeated.
Gradually the mental disorder becomes more intense, and the intervals
between its returns of shorter duration, until they are scarcely, or not at
all perceptible. The patient lies on his back, his eyes, if open, presenting
a dull and listless look, and is almost constantly talking to himself in a
low, muttering tone. Regardless of persons or things around him and scarcely
capable of recognizing them when aroused by his attendants, his mind retires
within itself to dwell upon the scenes and events of the past, which pass
before it in wild and disorderly array, while the tongue feebly records the
varying impressions, in the form of disjointed, incoherent discourse, or of
senseless rhapsody. In the delirium which occurs towards the end of chrome
diseases, the discourse is often more coherent and continuous, though the
mind is no less absorbed in its own reveries. As the disorder advances, the
voice becomes more indistinct, the fingers are constantly picking at the
bed-clothes, the evacuations are passed insensibly, and the patient is
incapable of being aroused to any further effort of attention. In some
cases, delirium is attended with a greater degree of nervous and vascular
excitement, which more or less modifies the abovementioned symptoms. The
eyes are open, dry, and bloodshot, intently gazing into vacancy, as if fixed
on some object which is really present to the mind of the patient; the skin
is hotter and dryer; and he is more restless and intractable. He talks more
loudly, occasionally breaking out into cries and vociferation, and tosses
about in bed, frequently endeavoring to get up, though without any
particular object in view." Ray, Med. Jur. Sec. 213.
4. "So closely does delirium resemble mania to the casual observer, and
so important is it that they should be distinguished from each other, that
it may be well to indicate some of the most common and prominent features of
each. In mania, the patient recognizes persons and things, and is perfectly
conscious of, and remembers what is passing around him. In delirium, he can
seldom distinguish one person or thing from another, and, as if fully
occupied with the images that crowd upon his memory, gives no attention to
those that are presented from without. In delirium, there is an entire
abolition of the reasoning power; there is no attempt at reasoning at all;
the ideas are all and equally insane; no single train of thought escapes the
morbid influence, nor does a single operation of the mind reveal a glimpse
of its natural vigor and acuteness. In mania, however false and absurd the
ideas may be, we are never at a loss to discover patches of coherence, and
some semblance of logical sequence in the discourse. The patient still
reasons, but he reasons incorrectly. In mania, the muscular power is not
perceptibly diminished, and the individual moves about with his ordinary
ability. Delirium is invariably attended with great muscular debility; and
the patient is confined to bed, and is capable of only a momentary effort of
exertion. In mania, sensation is not necessarily impaired and, in most
instances, the maniac sees, bears, and feels with all his natural acuteness.
In delirium, sensation is greatly impaired, and this avenue to the
understanding seems to be entirely closed. In mania, many of the bodily
functions are undisturbed, and the appearance of the patient might not, at
first sight, convey the impression of disease. In delirium, every function
suffers, and the whole aspect of the patient is indicative of disease. Mania
exists alone and independent of any other disorder, while delirium is only a
symptom or attendant of some other disease. Being a symptom only, the latter
maintains certain relations with the disease on which it depends; it is
relieved when that is relieved, and is aggravated when that increases in
severity. Mannia, though it undoubtedly tends to shorten life, is not
immediately dangerous; whereas the disease on which delirium depends,
speedily terminates in death, or restoration to health. Mania never occurs
till after the age of puberty; delirium attacks all periods alike, from
early childhood to extreme old age." Id. Sec. 216.
5. In the inquiry as to the validity of testamentary dispositions, it
is of great importance, in many cases, to ascertain whether the testator
labored under delirium, or whether he was of sound mind. Vide Sound mind;
Unsound mind; 2 Addams, R. 441; 1 Addams, Rep. 229, 383; 1 Hagg. R. 577; 2
Hagg. R. 142; 1 Lee, Eccl. R. 130; 2 Lee, Eccl. R. 229; 1 Hag. Eccl. Rep.
256.

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